21st September 1997


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When fear becomes panic

Psychologists and psychiatrists now dwell much less on the early triggers of anxiety. They may be of historical interest, but the important thing according to the experts, is to modify sufferers’ present thinking and anxious behaviour

AImost imperceptibly, Andrew Clarke’s confidence ebbed away. He was 43, and at the peak of an enviably successful career as a construction engineer, when he began to avoid any form of socialising.

Andrew was used to talking to 200 people at a time but he got to a point where, he says: “I became so anxious at the prospect of having to give a presentation to just three or four people that I would offload the task on to someone else.”

His fear grew over the next few years, and he started to avoid not just presentations, but all meetings, whether he was speaking or not. “Dinner parties and drinks with colleagues became a no-no. Parties were a disaster area and eating out in restaurants was the worst of all - I simply could not talk to people.”

Highly valued at work, he managed to keep going, while battling to overcome his bewilderings anxiety - sometimes labelled social phobia. “I often travelled on business to America where bookshops were full of self-help books by people who claimed to have conquered this or that fear. I read them eagerly, but they were of little help.”

As his panic attacks became more frequent, the symptoms included sudden suffocating feelings of breathlessness, dizziness, sweating and nausea. Overbreathing, known as hyperventilation, gave him tingling fingers, muscle pain and ringing in the ears. These symptoms can be so bad in some cases, that onlookers think a stroke or heart attack is taking place.

Eventually, Andrew overcame his fears with the help of the structured approach encouraged by Triumph Over Phobia (TOP), a British charity based in Bath, western England. Its programme gradually exposed Andrew to situations he once avoided or feared and provided him with a self-help group of fellow sufferers for support.

The TOP cure has become so successful that the charity plans to double its number of groups. “We have 13 at present, but have just been given British National Lottery money to expand,” says Celia Bonham Christie, TOP founder and president.

Her interest was sparked after she conquered her fear of flying 15 years ago. “People come to us who are at the end of the road. One woman, who was given our name by the Samaritans, was suicidal because she feared she was seriously ill.

“Some people are so terrified by the prospect of supermarkets or offices that they remain house-bound for 10 years or more. SadIy, these fears and anxieties still carry a stigma, and many people do not realise that they are suffering from a devastating illness from which they can recover.”

Tranquillising drugs may help, but only as a temporary crutch to give people the courage to help themselves.

The TOP approach is based on cognitive behavioural therapy. It combines gaining insights into disordered negative thinking with staged changes in behaviour and has won international recognition in recent years as a way to break through such ingrained conditions as fears, depressions, addictions and even some eating disorders.

Only when Andrew was referred by a psychiatrist to TOP, after struggling on his own for nearly seven years, did he make progress.

“First, you make a list of every situation you have been avoiding, starting with the least troublesome,” he says.

“Then, you agree to make a contract with yourself and the group, to carry out a specified task each week. My first task was to buy my paper at the news agent instead of having it delivered.

“Even this was difficult:

I would go very early to avoid having to talk to people queueing up, as this would make me sweaty and shaky. But it is crucial to succeed with the tasks otherwise you feel depressed by failure. The group dynamic is very important in encouraging confidence.”

Gradually, Andrew worked through his graded list: he initiated discussions in shops, went to clubs, travelled on buses, shopped in supermarkets, ate out with his family and then with friends, hosted dinner parties and finally addressed large meetings. Fortunately, he never had any problems talking to his wife, children or doctor.

He turned a vital corner when he was set the task of telling his colleagues about his fears. “I was nerve-racked, but they were very sympathetic, which made me think that, with obvious exceptions, more people than we realise struggle against all kinds of anxiety. It is as if there is a thin red confidence line. Mostly, we stay on the right side of it, but at different times in life we may move across.”

According to British psychologists, around one in 10 people will be suffering from some sort of anxiety problem at any time and most will suffer at least one or two panic attacks during their lifetime.

Andrew thinks his type of anxiety might have been triggered by his being in a stressful situation while feeling physically low. He remembers having to speak at a conference shortly after a bad bout of flu.

“I felt dizzy during the talk and struggled through by gripping the table. Subconsciously, I may have become anxious afterwards that it would recur.”

Psychologists and psychiatrists now dwell much less on the early triggers of anxiety. They may be of historical interest, but the important thing, according to the experts, is to modify sufferers’ present thinking and anxious behaviour.

Andrew, who retired recently, now has no problem in talking to a room full of people and once more enjoys dinner parties and eating out. But he does not claim to be cured. “You can slide back, which is why the graded approach is so helpful.

It means that you can always go back to carrying out your home-work.”

And even when things seem to be back to normal, Andrew says it is important to remain vigilant.

“A curious thing happens just as you are almost completely well. It as if the enemy - your fear, which you are just about to ditch - has become a perverse friend. You feel suddenly insecure at the thought of living without the fear. I now work voluntarily with TOP and see many people going through the same feeling. At this point, group support can be vital.” -Daily Telegraph

Six ways to beat bad thoughts

It is all too easy to slip into the unbalanced thinking that distorts the underlying worries, says Dr. Helen Kennerley, a clinical psychologist who works in London and Oxford.

Below is a brief guide taken from her book Overcoming Anxiety: A Self-help Guide to Cognitive Behavioural Techniques (pub. in Britain). Her message is to recognise the signs within yourself and avoid repeating these psychological traps.

Catastrophising: Always assuming the worst: the official envelope is a high tax demand; minor surgery will result in death; a scowl from a colleague implies hatred; a chest pain heralds a heart attack; or a sore throat means you will never finish a project and your reputation will be damaged for ever.

Black and white thinking: Seeing everything in all-or-nothing terms, such as: “I will always feel this badly,” rather than “I could get better with help”. It is the stressful thinking of perfectionists: “It is not perfect, so I have failed.” Exaggerating: jumping to conclusions by, say, magnifying your minor errors and living in terror of redundancy. Such thinking can so fuel anxiety that you might well make more mistakes. Ignoring the positive: Filtering out reassuring facts and not acknowledging your own strengths. Examples are a nurse who ignores thanks from many patients and focuses on one criticism; or the teenager who is so unhappy with her hair she dismisses compliments from friends. Mood changes: A surge of anxiety can prevent you dealing with a problem and make you feel ever more hopeless. Try to catch worrying feelings early and displace them with a speedy relaxation technique.

Scanning: Always on the look-out for what you fear - for example, searching for spiders in dusty corners, or dwelling on aches and pains that most people would dismiss or scarcely notice.

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